September 7, 2008

Building and Sustaining a Multiuniversity and Multicampus Program or School of Public Health

Drawing from New Jersey's successful efforts and from other less successful efforts, we offer lessons learned for those who will consider a multiuniversity and multicampus program or school of public health. These lessons include building a faculty collaboration, senior administrative support, and external constituencies and developing a set of documents that institutionalize processes, logistics, and other operations. In our experience, building and sustaining faculty support is the greatest challenge, followed by protecting existing resources and securing additional resources when administrators in the host universities change. (Am J Public Health. 2008;98:1556-1558. doi:10.2105/ AJPH.2008. 136705)

SINCE 1997, THE NUMBER OF graduate public health schools and programs has grown remarkably, from 32 to 40 accredited schools and from 25 to 69 accredited graduate programs. Nearly all of these programs and schools use a single-university model. We describe an exception to this traditional model-the establishment of a multiuniversity and multicampus public health academic educational initiative in New Jersey. This initiative resulted from compact geography, a history of cooperation among faculty, and the need for graduate and undergraduate public health educational programs. The endeavor has been sustained by ongoing cooperation among the partners.

To date, no other universities have been able to build and sustain an accredited graduate school of public health sponsored by a multiuniversity partnership. Nevertheless, this model probably provides the best framework for areas with geographically dispersed faculty and student bodies, a need for public health training but insufficient resources to immediately offer programs, and government, for-profit, and not-for-profit political and financial support. Some novel models have been created in other professions- for example, ones that adapt an engineering curriculum to meet community needs1,2 or that provide education for specialists in autism.3

After briefly describing the development of the former New Jersey graduate program that evolved into a graduate school of public health, we describe the lessons that we learned for building and sustaining a school of public health through a multiuniversity partnership. We provide examples of some efforts that failed- without giving the names of the institutions, however, and with the caveat that we participated as outsiders in these efforts and therefore cannot be entirely certain that our expressed reasons for why they failed are accurate.

BUILDING A NEW PROGRAM AND SCHOOL IN NEW JERSEY

During the late 1970s, faculty and staff at the University of Medicine and Dentistry of New Jersey (UMDNJ; formerly the College of Medicine and Dentistry of New Jersey) and Rutgers University observed that New Jersey was a densely populated state without an in- state graduate program or school of public health. The state had pockets of poverty and corresponding public health problems, high cancer mortality rates, major environmental health-related issues, and other public health problems that would benefit by having more public health professionals trained at the undergraduate and graduate levels. In addition, state and local health officials were required to go out of state for advanced public health training and pressed the faculty at UMDNJ and Rutgers to start a public health program.

At that time, however, neither university could provide the resources needed to immediately launch an academic program, and representatives of each university observed that their strengths were complementary: one university was strong in environmental and occupational health, health education, and biostatistics, the other in health care, epidemiology, behavioral sciences, and environmental health. Also, the 2 universities were in 3 locations within New Jersey. In the central location, Piscataway/New Brunswick, the 2 universities had a long history of cooperation in research and teaching programs. Consequently, key faculty at both universities in this area led the effort to create the first collaborative graduate program in public health accredited by the Council on Education for Public Health. By 2001, US News and World Report rated the New Jersey Graduate Program in Public Health second among all graduate public health programs in the United States.4

Whereas UMDNJ took the lead regarding graduate education, Rutgers had slowly been building an undergraduate degree with public health as the major subject. In 1999, 5-year bachelor of science and master of public health degrees were established between the Rutgersbased undergraduate program and the graduate program based at UMDNJ.

The university leaders decided to expand the program into a multicampus school of public health. Among the most compelling reasons was that the program, located in the central part of the state, was not convenient for the public health workforce located in the northern and southern parts of the state. In 1998, building on the foundation of the former New Jersey Graduate Program in Public Health, UMDNJ, Rutgers University, and the New Jersey Institute of Technology officially established the University of Medicine and Dentistry of New Jersey School of Public Health. By opening one campus in the northern part of the state and another in the southern part, the school increased the number and expertise of its faculty and substantially increased the ethnic and racial diversity of its student body.

STARTING A PARTNERSHIP

It takes time to develop a workable plan and even more time to build a faculty, especially when faculty members are drawn from more than one university, each with multiple campuses. Starting small- with just a program-and being cautious about what is promised to faculty, university administrators, and state and local constituents increase the likelihood of building the faculty and resource base necessary for a school. In one case, for example, 3 public universities tried but failed to build a public health program, largely because they could not reach consensus on specialty areas. Despite the urging of outsiders to begin with the core subject clusters (e.g., epidemiology, health care organization and administration), they had made promises about specialty areas that exceeded the capacity of existing faculty resources.

We offer the following suggestions for building a faculty:

* Program priorities. Build from a core of faculty who know and respect each other and agree to work together to achieve the program and school priorities.

* Joint planning and teaching. Collaborative planning and teaching of core courses, specialty areas, and dual-degree programs are effective ways of getting unacquainted faculty to work together. The UMDNJ-Rutgers effort has led to erstwhile strangers becoming career-long colleagues and to joint research and service projects. It is a marvelous benefit of a partnership.

* Seed funds. Set aside funds for "seed grants" that are available only to applicants from at least 2 of the institutions or, in some cases, different departments within the same university.

* Seminars. Provide funds for joint seminars; some of these may be broadcast to the partner institutions as well as to state and local health departments.

* Coterminous appointments. Provide faculty with unqualified appointments coterminous with the primary appointment at the home school and at the same rank. These do not change salary or tenure status at the home department and school, but they are valued by faculty members.

* Avoidance of split faculty lines. We have found that as administrators change, the original agreements between departments or institutions become increasingly muddled. The faculty member on a split line- that is, reporting to 2 different departments or schools- is in a difficult political position. How to submit grants often becomes contentious, and how to handle his or her tenure packet may be fraught with pitfalls.

A collaborative program or school requires strong institutional support from each partner. Some senior administrators will be enthusiastic about the idea. Others, especially if they do not have a public health background, may be lukewarm or even hostile. This latter group may feel, with some justification, that a new program or school will require removing faculty, grants, and other resources from their control and turning them over to a public health unit, which they consider a competitor. We have observed instances where there was considerable faculty commitment but where support from senior administrators at one of the institutions was withheld or withdrawn with changing circumstances. In one case, for example, 1 of 3 potential university partners withdrew because the dean of one school would not commit his faculty without state resources for a major physical expansion.

Senior administrators must be persuaded that there is a clear benefit to their institution. A number of administrative mechanisms have been effective for us. First, revenue earned for teaching should back go to the institution that the faculty member was taken from. Approximately 65% of the revenue generated from a public health course at our universities now follows the instructor back to his or her institution. Second, enhance the mission- that is, add to the universities' teaching, research, and service capacity. In our case, Rutgers University developed an undergraduate public health program during the 1970s. The university did not provide a substantial amount of resources to support a degree in that major subject until senior administration was persuaded that the resources would be used to hire faculty members to teach in both the undergraduate and graduate program in public health. On the UMDNJ side, the graduate program (now school) provided the institution with a new graduate academic specialty in public health and enabled UMDNJ to partner with Rutgers in an endeavor that was popular across the state.

Third, retain a well-known public health academician or public health practitioner to conduct a site visit and evaluate the need for a collaborative program or school. Fourth, develop a memorandum of agreement that describes resources, faculty commitment, and a host of other issues that may seem innocuous but can be quite important to faculty and students, such as parking, computer and library access, and cross registration.

Fifth, as soon as possible, the potential partners should build a coalition comprising public health practitioners from state and local government, for-profit organizations, and not-for-profit groups to support the idea of a collaborative program or school of public health. It is incumbent upon the proponents to secure as many resources as possible as early as possible. Once the school is opened, and especially after it has been operating for a few years, it is difficult to go back to government officials and not-for- profit organizations to request additional resources. In addition, elected officials-and therefore priorities-may have changed. It is a mistake to think that the school leadership must initially concentrate on building the academic program and later focus on getting external financial support, because later may be never.

Sixth, explain the need for a public health program or school. Peer reviewers will need an explanation of how a multiuniversity campus will work for students, faculty, staff, and others. The leadership must demonstrate that it has direct access to senior university management at each of the partner institutions. The accrediting body will be focusing on the program or school's ability to control its resources, curriculum, faculty, and other elements as delineated in the accreditation criteria for schools of public health5 and public health programs.6 The accrediting body will also want to see evidence that the organizers have worked out or are working on the nitty-gritty logistical details of operating an academic enterprise, such as scheduling, comparable grading systems, measuring the teaching and administrative contribution of faculty, library access, and others.

SUSTAINING THE PARTNERSHIP

Inevitably, administrators are replaced, faculty leave, and interests change. At some point, a dean, chair, or faculty member is going to want to change the rules of engagement about faculty participation, irrespective of the memorandum of agreement. Directors of joint programs and schools must have a plan B and plan C in hand. The same is true of new resources. Not only is the program or school of public health unlikely to obtain new resources after the initial period, but during a financial crisis it is likely to be squeezed, especially at the nonlead institution. It is vulnerable because the other deans and chairs at the collaborating institution will assert that the "core" programs must be protected.

We make the following suggestions for sustaining the partnership. First, keep existing faculty committed. In addition to the inducements described earlier, others should be developed. Partners can develop faculty awards for research, teaching, and service. Joint recognition of public health at each partner's graduation exercises and joint grant programs are 2 ways to keep faculty from partner institutions communicating and working with each other.

Second, use any public or private opportunity to meet with university leadership to remind them of the importance of public health. One way is to have the school sponsor a conference that is opened by a senior university official, who is then followed by a major elected official, commissioner of health or environment, or public health foundation executive.

Third, be alert for opportunities. To the multiuniversity program or school, the retiring and hiring of faculty can be a major opportunity or a serious blow. The key is for representatives of the program or school of public health to be involved in hiring new faculty at the partner institutions. Try to have a representative of the school of public health participate as a member of the search committee at the hiring institution. Offer part of a startup package as an inducement to the department program chair to hire a new faculty member who will make a contribution to the school of public health.

Fourth, prepare for the worst case of one partner entirely pulling out of the collaborative agreement. If a partner does not want to continue to participate, it is better to formalize the divorce rather than engage in a protracted dispute about what the memorandum of agreement includes.

SUMMARY

Building and sustaining a multiuniversity and multicampus program or school of public health is challenging. There are more meetings, more documents to prepare for and provide to more committees, and always more people to persuade and motivate; simply stated, there is more complexity involved with the effort than with the traditional singleuniversity and single-location model. The advantages are that this nontraditional model develops partnerships among a geographically diverse set of faculty, staff, external supporters, students, and alumni; maximizes state resources to conduct research; provides services for local communities; and strengthens the skills of public health practitioners. We believe that the model provides a "win-win" opportunity that is worth the effort.

Michael R. Greenberg and Dona Schneider are with the E. J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ. Audrey Gotsch and George Rhoads are with the School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway/New Brunswick.

Requests for reprints should be sent to Michael R. Greenberg, PhD, E. J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Ave, New Brunswick, NJ 08901-1958 (e- mail: [email protected]).

This commentary was accepted May 18, 2008.

Contributors

M.R. Greenberg wrote the drafts of the commentary. A. Gotsch, G. Rhoads, and D. Schneider added elements and commented on drafts.

Acknowledgments

Many faculty members, administrators, staff, and board members from the University of Medicine and Dentistry of New Jersey, Rutgers, and the New Jersey Institute of Technology have supported this collaborative effort, far more than we can acknowledge here. Nevertheless, we would like to acknowledge the following key faculty members and administrators from the University of Medicine and Dentistry of New Jersey and Rutgers who contributed to the initial establishment and early growth of this collaborative effort: Stanley S. Bergen Jr, Edward Bloustein, Stewart Cook, Michael Gallo, Michael Gochfeld, Bernard Goldstein, James Hughes, Alexander Pond, Richard Reynolds, and Kenneth Wolfson.

Copyright American Public Health Association Sep 2008

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